Abstract
Introduction
Vertebroplasty and balloon kyphoplasty have shown to improve pain and functional outcome
in cases with symptomatic vertebral fractures. Although restoration of the vertebral
body height and kyphosis seemed to be easier with balloon kyphoplasty, it became clear
that some of the correction achieved by the balloon is lost once it was deflated.
Vertebral body stent was developed to eliminate this phenomenon. To our knowledge
this is the first study in describing this technique in clinical settings.
Materials and methods
Seventeen patients with 20 fractured vertebral bodies were included. All fractures
were Type A1.3 or A3.1 (incomplete burst). Information about pain (visual analogue
scale-VAS) and function (Oswestry disability index-ODI) and vertebral body deformity
(vertebral angle-VA) was recorded in a prospective way at regular intervals. Patients
were classified into osteoporotic group (7 patients) and traumatic groups (10 patients,
younger than 60 years).
Results
There were 6 male and 11 female patients with mean age of 58.1 years (31–88 years).
Mean follow up was 12 months. The preoperative pain level showed a mean VAS score
of 8.9 in osteoporotic group and 9.7 in traumatic group. Postoperatively, in osteoporotic
group, mean VAS was 4.8 at 6 weeks, 4.0 at 6 months and 2.5 at 12 months compared
with traumatic fracture group where it was 2.7 at 6 weeks, 2.2 at 6 months and 1.6
at 12 months. Mean ODI in osteoporotic group was 41.7% (14–58%) and in traumatic group
it was 20.4% (6–33%). Mean vertebral body angle prior to surgery in osteoporotic group
was 9.7 whilst postoperatively it was 5.2°; so the mean correction achieved was 4.5°.
In traumatic group preoperative VA was 13° whilst postoperatively it was 5.7°; therefore
the mean correction achieved was 7.3°. None of the patients lost reduction at their
last follow up.
Conclusion
Vertebral body stenting leads to satisfactory improvement in pain, function and kyphosis
correction in the treatment of osteoporotic and traumatic fractures. Anterior spinal
column, especially the fragmented superior endplate is nicely reconstructed by the
stent provided it is inserted accurately. With addition of posterior transpedicular
instrumentation, indications for this technique may be wider covering some Type B
and C fractures with similar vertebral body damage.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures.Neurosurgery. 2001; 49: 1105-1114
- Preliminary results with modified techniques of balloon kyphoplasty for vertebra plana, traumatic fractures and neoplasms.Acta Orthop Belg. 2006; 72: 187-193
- Suitability of a calcium phosphate cement in osteoporotic vertebral body fracture augmentation: a controlled, randomized, clinical trial of balloon kyphoplasty comparing calcium phosphate versus polymethylmethacrylate.Spine (Phila Pa 1976). 2009; 34: 108-114
- Treatment of type-A3 amyelic thoracolumbar fractures (burst fractures) with kyphoplasty: initial experience.Radiol Med. 2009; 114: 133-140
- A lethal pulmonary embolism during percutaneous vertebroplasty.Anesth Analg. 2002; 95: 1060-1062
- Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases.Radiology. 2003; 226: 366-372
- Percutaneous pedicle screw fixation and kyphoplasty for management of thoracolumbar burst fractures.Neurochirurgie. 2007; 53: 272-276
- Vertebral body stenting. A method for repositioning and augmenting vertebral compression fractures.Orthopade. 2002; 31: 356-361
- Note préliminaire sur le traitement des angiomes vertébraux par vertébroplastie acrylique percutanée.Neurochirurgie. 1987; 33: 166-167
- New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.Spine. 2001; 26: 1511-1515
- Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty.Rheumatology (Oxford). 2000; 39: 1410-1414
- The evaluation of balloon kyphoplasty for osteoporotic vertebral fractures. An interdisciplinary concept [in German].Orthopade. 2004; 33: 893-904
- Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study.J Bone Miner Res. 2005; 20: 604-612
- Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures.Spine (Phila Pa 1976). 2008; 33: 658-667
- Vertebroplasty: Cement leakage into the disc increases the risk of new fracture of adjacent vertebral body.Am J Neuroradiol. 2004; 25: 175-180
- A comprehensive classification of thoracic and lumbar injuries.Eur Spine J. 1994; 3: 184-201
- Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction.J Bone Joint Surg Am. 2009; 91: 20-28
- The load sharing classification of spine fractures.Spine (Phila Pa 1976). 1994; 19: 1741-1744
- Percutaneous vertebroplasty: an experience of 31 procedures.Neurol India. 2003; 51: 490-492
- Treatment of thoracolumbar junction burst fractures (Magerl A3) by balloon kyphoplasty: anatomic study.Rev Chir Orthop Reparatrice Appar Mot. 2007; 93 (French): 666-673
- Percutaneous vertebroplasty: long-term clinical and radiological outcome.Neuroradiology. 2002; 44: 950-954
- Balloon kyphoplasty combined with posterior instrumentation for the treatment of burst fractures of the spine, 1 year results.J Orthop Trauma. 2009; 23: 126-131
- Vertebral body stenting: a new method for vertebral augmentation versus kyphoplasty.Eur Spine J. 2010; 19: 916-923
- Percutaneous vertebral augmentation.Spine J. 2004; 4: 218-229
- Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty.Osteoporos Int. 2001; 12: 429-437
- Acute respiratory distress syndrome associated with pulmonary cement embolism following percutaneous vertebroplasty with polymethylmethacrylate.Spine. 2004; 29: E294-E297
Article info
Publication history
Accepted:
April 12,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
